Understanding the impact of survival and human papillomavirus tumor status on timing of recurrence in oropharyngeal squamous cell carcinoma.
Understanding the impact of survival and human papillomavirus tumor status on timing of recurrence in oropharyngeal squamous cell carcinoma.
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DOI：
10.1016/j.oraloncology.2015.10.016
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发表时间：
2016-01
期刊：
影响因子：
4.8
通讯作者：
Fakhry C
中科院分区：
文献类型：
--
作者：
Guo T;Rettig E;Fakhry C
人乳头瘤病毒（HPV）阳性肿瘤状态与口咽鳞状细胞癌（OPSCC）疾病复发后预后改善相关。在这项研究中，考虑到文献中相互矛盾的证据，评估了生存偏倚在HPV肿瘤状态和复发时间之间关系中的潜在作用。对先前发表的已知HPV肿瘤状态的复发性OPSCC的回顾性两机构研究进行了二次分析。患者被分为“早期”（存活<24个月）或“晚期”存活者（>=24个月）。采用Kaplan-Meier和考克斯比例风险法分析首次复发的时间和总生存期。双侧p值<0.05被认为是显著的。共有101例患者符合标准，包括81例晚期和20例早期存活者。HPV阳性肿瘤状态与晚期生存者的复发时间较长相关（中位数21.8 vs 13.8个月，p=0.028）。晚期生存者在HPV阳性（p<0.001）和HPV阴性（p=0.0096）患者中有晚期复发，在局部（p<0.0001）和远处转移复发（p<0.0001）患者中也有晚期复发。在多变量分析中，HPV阳性肿瘤状态（校正HR[aHR] 0.48，p=0.006）和超过24个月的生存率（aHR 0.21，p<0.001）与后期复发相关。分层时，HPV肿瘤状态仅与晚期存活者的晚期复发相关（aHR 0.47，p=0.015）。晚期生存率与HPV阳性和阴性患者的晚期复发相关。按生存期分层说明了生存偏倚如何将晚期生存与晚期复发联系起来，并有助于我们理解HPV肿瘤状态对复发时间的影响。
Human papillomavirus (HPV)-positive tumor status is associated with improved prognosis after disease recurrence in oropharyngeal squamous cell carcinoma (OPSCC). In this study the potential role of survival bias in the relationship between HPV tumor status and the timing of recurrence was evaluated, given conflicting evidence in the literature. A secondary analysis was performed on a previously published retrospective two institution study of recurrent OPSCC with known HPV tumor status. Patients were categorized as “early” (surviving <24 months) or “late” survivors (>=24 months). Timing of first recurrence and overall survival were analyzed using Kaplan-Meier and cox proportional hazard methods. Two-sided p-values <0.05 were considered significant. In total 101 patients met criteria including 81 late and 20 early survivors. HPV-positive tumor status was associated with longer time to recurrence in late survivors (median 21.8 vs. 13.8 months, p=0.028). Late survivors had later recurrences in HPV-positive (p<0.001) and HPV-negative patients (p=0.0096), as well as in both locoregional (p<0.0001) and distant metastatic recurrence (p<0.0001). In multivariate analysis, both HPV-positive tumor status (adjusted HR[aHR] 0.48, p=0.006) and survival beyond 24 months (aHR 0.21, p<0.001) were associated with later recurrence. When stratified, HPV tumor status was only associated with later recurrence in late survivors (aHR 0.47, p=0.015). Late survivorship was associated with late recurrence for both HPV-positive and HPV-negative patients. Stratification by survival illustrates how survival bias links late survivorship with late recurrences and contributes to our understanding of the impact of HPV tumor status on the timing of recurrence.